title: Randomised trial of volume-targeted ventilation versus pressure-limited ventilation in acute respiratory failure in prematurely born infants.
abstract: BACKGROUND
  During volume-targeted ventilation (VTV), a constant volume is delivered with each ventilator inflation.
  
  
  OBJECTIVE
  To determine whether VTV compared to pressure-limited ventilation (PLV) reduced the time to reach weaning criteria in prematurely born infants with acute respiratory distress, and if any difference was explained by better respiratory muscle strength and/or a lower work of breathing (WOB).
  
  
  METHODS
  Infants of <34 weeks of gestational age ventilated for <24 h in the first week after birth were randomised to receive either VTV or PLV. The primary outcome was the time to achieve pre-specified weaning criteria. Respiratory muscle strength was assessed by the measurement of the maximum inflation and expiratory pressures, and the WOB assessed by the transdiaphragmatic pressure time product. Other outcomes reported are the duration of ventilation, occurrence of patent ductus arteriosus, pneumothorax, intraventricular haemorrhage, periventricular leukomalacia and episodes of hypocarbia.
  
  
  RESULTS
  Forty infants, median gestational age 27 (range 23-33) weeks, were recruited. The time taken to achieve weaning criteria was similar in the two groups [median 14 h (VTV) vs. 23 h (PLV)]. There were no significant differences between the groups with regard to respiratory muscle strength, WOB or other outcomes, except that fewer of the VTV compared to the PLV group had episodes of hypocarbia (8 vs. 19; p < 0.001).
  
  
  CONCLUSIONS
  In prematurely born infants with acute respiratory failure, use of VTV did not reduce the time to reach weaning criteria, but was associated with a reduction in episodes of hypocarbia.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
authors.forename: Olie
authors.initials: O
authors.lastname: Chowdhury
authors.forename: Deena-Shefali
authors.initials: DS
authors.lastname: Patel
authors.forename: Simon
authors.initials: S
authors.lastname: Hannam
authors.forename: Silke
authors.initials: S
authors.lastname: Lee
authors.forename: Gerrard F
authors.initials: GF
authors.lastname: Rafferty
authors.forename: Janet L
authors.initials: JL
authors.lastname: Peacock
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D000208:Acute Disease; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D012119:Respiration; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000503:physiopathology* / Q000628:therapy*; D012132:Respiratory Muscles / Q000503:physiopathology; D016896:Treatment Outcome